<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Fa_case_uuid')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-fa_case_uuid" class="form-control" name="row[fa_case_uuid]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Fa_case_code6')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-fa_case_code6" class="form-control" name="row[fa_case_code6]" type="number">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Fa_case_openid')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-fa_case_openid" class="form-control" name="row[fa_case_openid]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Fa_case_phone')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-fa_case_phone" class="form-control" name="row[fa_case_phone]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Fa_case_uname')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-fa_case_uname" class="form-control" name="row[fa_case_uname]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Fa_case_uage')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-fa_case_uage" class="form-control" name="row[fa_case_uage]" type="number">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Fa_case_usex')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-fa_case_usex" class="form-control" name="row[fa_case_usex]" type="number">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Fa_case_text')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-fa_case_text" class="form-control " rows="5" name="row[fa_case_text]" cols="50"></textarea>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Fa_case_remark')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-fa_case_remark" class="form-control" name="row[fa_case_remark]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Fa_case_channelid')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-fa_case_channelid" class="form-control" name="row[fa_case_channelid]" type="number">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Fa_case_frontpoint')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-fa_case_frontpoint" class="form-control" name="row[fa_case_frontpoint]" type="number">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Fa_case_backpoint')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-fa_case_backpoint" class="form-control" name="row[fa_case_backpoint]" type="number">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Fa_case_imagebefore')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-fa_case_imagebefore" class="form-control" name="row[fa_case_imagebefore]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Fa_case_imageafter')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-fa_case_imageafter" class="form-control" name="row[fa_case_imageafter]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Fa_case_createtime')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-fa_case_createtime" data-rule="required" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[fa_case_createtime]" type="text" value="{:date('Y-m-d H:i:s')}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Fa_case_updatetime')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-fa_case_updatetime" data-rule="required" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[fa_case_updatetime]" type="text" value="{:date('Y-m-d H:i:s')}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Fa_case_channeluuid')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-fa_case_channeluuid" class="form-control" name="row[fa_case_channeluuid]" type="text">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
        </div>
    </div>
</form>
